Following several years of steady progress toward elimination of measles in the WHO European Region, the number of countries having achieved or sustained elimination of the disease has declined. This was the conclusion of the European Regional Verification Commission for Measles and Rubella Elimination (RVC) based on an assessment of annual status updates for 2018 submitted by the 53 Member States of the Region.

The RVC determined that for the first time since the verification process began in the Region in 2012, 4 countries (Albania, Czechia, Greece and the United Kingdom) lost their measles elimination status.

“Re-establishment of measles transmission is concerning. If high immunization coverage is not achieved and sustained in every community, both children and adults will suffer unnecessarily and some will tragically die,” says Dr Günter Pfaff, Chair of the RVC.

The RVC was, on the other hand, pleased to conclude that Austria and Switzerland attained elimination status, having demonstrated the interruption of endemic transmission for at least 36 months.

For the Region as a whole, as of the end of 2018, 35 countries are considered to have achieved or sustained measles elimination (compared to 37 for 2017), 2 have interrupted the endemic transmission of measles (for 12–35 months), 12 remain endemic for measles and 4 that had previously eliminated the disease have re-established measles transmission.

The surge in cases that began in 2018 has continued into 2019, with approximately 90 000 cases reported for the first half of the year. This is already more than that recorded for the whole of 2018 (84 462).

Emergency response to measles circulation in the Europe Region

The ongoing circulation of measles in the Region continues to be internally classified within WHO as a Grade 2 emergency. This designation allows the Organization to mobilize the technical, financial and human resources needed to support the affected countries.

“Great efforts to control this highly contagious disease have brought us a long way towards regional elimination. However, ongoing measles outbreaks demonstrate that more is needed. Through activation of the emergency response, WHO has increased its focus on measles elimination and upgraded its action. This is the time and opportunity to address any underlying health system, social determinants and societal challenges that may have allowed this deadly virus to persist in this Region,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe.

A detailed epidemiological analysis of the measles situation in the Region as of mid-2019 is available in the most recent issue of WHO EpiBrief.

Elimination verification process

The RVC is an independent panel of experts that meets annually to assess measles elimination status in the Region based on extensive annual reports submitted by each country. It met on 12–14 June 2019 in Warsaw, Poland to evaluate reports for 2018 and based its conclusion on several factors including measles surveillance data, routine immunization coverage, outbreak response, and the reach of supplemental immunization campaigns and other activities.

The RVC also concluded that the situation for rubella has improved. 39 countries achieved or sustained elimination status (compared to 37 in 2017), 3 interrupted endemic transmission (compared to 5 in 2017) and 11 countries continue to be considered endemic for rubella

REGIONAL OVERVIEW

A dramatic resurgence of measles continues to threaten the health of susceptible individuals in the European Region. As measles typically peaks in the spring, the number of reported cases declined in June. However, approximately 90 000 children and adults in the Region were infected with measles in the first half of 2019. This is double the number of cases reported for the same period in 2018 (44175) and exceeds the total for 2018 (84462). For the 18-month period of 1 January 2018 to 30 June2019, 49 of the 53 countries of the Region together reported over 174000 measles cases and over 100 measles-related deaths. On 6 May 2019, WHO activated a Grade 2 emergency response to measles circulation in the European Region. This allows WHO to mobilizethe needed human and financial resources to support the affected countries.Based on the continued need for an enhanced tailored response to the spread of measles, on 5 August 2019 the emergency activation was extended for another 3-month period when it will be reassessed

Reported measles cases in the WHO European Region, January 2017–June2019.Source:    Monthly    aggregated    case-based    data    reported    by    Member    States    to WHO/Europe, directly or via ECDC/TESSy, data as of 30 July 2019

Risk assessment and emergency grading

The assessment of the measles situation in the Region considered number of cases, pockets of vulnerability within countries and the need for accelerated action to stop circulation and prevent future outbreaks. Grading the measles emergency triggered the activation of WHO’s Incident Management System (IMS), which provides a standardized yet flexible approach to managing WHO’s response to the emergency. Since the Grade 2 response activation, WHO has reviewed the situation in all 53 Member States and grouped them based on the needs to contain the ongoing measles outbreak and their health system characteristics. A strategic response plan (SRP) for the entire Region is being prepared and WHO is supporting health authorities in Israel, Romania, Serbia and Ukraine in preparing/activating plans for outbreak response and identifying and addressing any underlying health system challenges that may have contributed to the measles outbreaks.

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